Cause for concern?

These are all natural feelings and although the feelings may be very intense for a short period, these changes will probably only be temporary. Support, patience and understanding will help you get back to normal. If these feelings are prolonged it might be helpful to discuss it with a GP who may be able to arrange for support or counselling.

Signs that something is not right

Sometimes changes in behaviour may indicate that a mental health problem is developing. Mental illnesses rarely come out of the blue. Almost always, these disorders are preceded by a gradual change in behaviour. This can happen over a relatively short period or over a number of months. Some of the changes you may see include:

• Becoming more anxious, irritable
• Becoming depressed or suicidal
• Difficulty in concentration or memory
• Being preoccupied with unusual new ideas, or odd beliefs
• Change in sleep patterns, lack of or too much sleep
• Changes in social behaviour, overly friendly or withdrawn
• Marked changes in mood
• Not able to function as previously, unable to cope with work or studies
• Becoming overly suspicious

What next?
The earlier a mental health problem is recognised and treated, generally the better the outcome. Getting help sooner rather than later can:

• Improve how fast a person recover
• Improve how much a person recovers
• Reduce the likelihood of relapse
• Reduce the likelihood of admission to hospital
• Reduce the stigma associated with mental illness
• Reduce time lost from work, school or college
• Reduce stress on family and friends

Where do I start?
If you or the person you are concerned about suspects that they are suffering from the onset of a mental illness it is important to seek medical help early. Helping someone must start by encouraging them to realise there is a problem and seek help. It will be important to:

• remember that the person may be anxious, frightened, confused or may feel that you are 'getting at them'
• be calm, sympathetic and tactful - It would be best to approach the subject when they seem to be relaxed and most likely to listen to you
• try to imagine how you would feel in their situation

You may try suggesting that:

• Stress, anxiety or other symptoms are making it difficult for them to cope as well as usual and that a doctor should be able to help
• You could arrange for you or someone else close to your relative/friend to accompany them to go to see a doctor.
• If your relative/friend has refused to see a doctor but you still believe that they are suffering from a mental health problem or that seeing a doctor may be able to help their symptoms, it may be time for you to seek help.

Your relative/friend’s GP would be a good place to start. You could start by writing a letter to them. Clearly describe the reasons for your concern tactfully. If the doctor seems unsympathetic you could try asking at reception if any of the doctors have special experience in working with people with mental health problems, and try contacting them.

You may be invited to talk over your concerns with the doctor you contacted, or you may want to make an appointment yourself. Once again, most people find it helpful to make a list of your reasons for concern. The doctor will appreciate factual statements about what has happened rather than opinions or vague descriptions; for example:

• my son does not come out of his room except to collect some food
• my sister never washes, and sleeps in her school clothes
• Jeremy has told me that I am not his mother and that his real mother is Madonna.

Any evidence of the changed behaviour would be useful, for example, comments made in a school report about deteriorating school work. You may want to make them aware if there is anyone else in the family that suffers from mental illness.

Common responses from doctors
Some doctors will treat your information and concerns with respect and will be willing to arrange for your friend/relative to be visited and assessed at home.

However, often doctors believe that it is not their role to assess someone for a mental health problem unless that person has approached them directly. Some doctors believe that in listening to the concerns of others they may be breaching their duty of confidentiality to their patient. This is not true and the duty of confidentiality does not prevent a doctor listening to your concerns. See the section on Confidentiality for more information

Asking for help elsewhere
If you still have concerns but you have been unable to get help from a doctor there are other people who may be able to help. You could try calling the local community mental health team and talking to a community psychiatric nurse (CPN).
In some areas, early intervention services have been set up to deal with young people between 14 and 35 who are experiencing their first episode of psychosis. They should assess anyone who may have symptoms of psychosis but are not necessarily confirmed as psychotic. Details of early intervention services in your area and how you can access them should be available from you local community mental health team.

The National Advice Service may be able to provide additional advice on getting medical help and if necessary an assessment.

Is there anything else I can do?
Additional factors can also trigger and maintain poor mental health as well as cause difficulties in assessing someone for a mental health problem. These can include the use of alcohol and drugs. This is because drugs and alcohol can:

• cause a change in someone's behaviour
• be used by people developing a mental health problem to make them feel better (often referred to as self-medicating)
• cause symptoms of mental illness such as paranoia
• trigger mental illness in some people.

You could make your friend or relative aware of these facts and perhaps encourage them to reduce their use of these substances.